WHY SHOULD YOU AND YOUR FAMILY HAVE MEDICAL AID?

South Africa has a dual healthcare system, consisting of public and private providers. Private hospitals are used mostly by members of medical schemes or those able to pay for these services out of their own pocket.

In laymen's terms, the purpose of a medical aid is to ensure that you are able to pay for treatment received from either a GP or specialist, or while in hospital.It is very important to "insure" your health. Accidents can happen and you and your family's health is unpredictable. If you cannot afford comprehensive cover, at least a basic hospital plan is recommended.

Do you know your options?

Traditional Plans (Comprehensive)These plans cover almost all medical expenses (subject to the rules of the individual scheme) and include benefits for in-hospital and day-to-day expenses (subject to the rules of the scheme).

Hospital Plans and Hospital with SavingsThese cover accounts submitted by service providers for treatment only while you are in hospital. You are responsible for your own day-to-day medical expenses. These plans cost less than comprehensive medical aid plans and are offered by every medical aid provider.

What is a medical savings account?The medical savings plan is designed to cover day-to-day expenses. The consumer contributes a fixed monthly amount to a savings account. The total annual amount available in the savings account is available, in advance, for medical expenses in that year.In terms of the medical scheme regulations, the amount may not exceed 25% of a consumer's annual premium. Once the benefit has been used up, the consumer is responsible for the day-to-day expenses. Any credit balance in the savings account at the end of the year is carried over to the next year.

What is a Capitation Plan (Network Option)?These plans provide individuals with basic day-to-day cover at affordable rates, at specific network providers. Network providers differ from scheme to scheme and members have to use designated service providers.Please note that some of the schemes have income categories. This means that what you pay every month for the plan is dependent on what you earn.

Do you know what your rights are?

The Medical Schemes Act (No 131 of 1998) came into effect on 1 January 2001. In terms of this Act:* There are standard-rate fees for people to join medical aid schemes regardless of their health or age.* There can be no discrimination on the grounds of people's health. For example, a medical scheme cannot refuse to allow someone to join because he/she is HIV-positive, or because he/she has asthma or diabetes.* The definition of dependants includes spouses (husband or wife) and natural and adopted children.* The new Act also sets out a complaints procedure for people who have a complaint against a medical scheme.